How do you exercise with a chronic condition or comorbidity? Is there hope for someone with these limitations to enjoy a life of movement and how can their friends and family help them?

Dr Elmo Pretorius is the expert that host, Ayanda Charlie, speaks to in this hope-inspiring episode of The Health Wrap: On The Move powered by Mediclinic. He is a specialist in both endocrinology and internal medicine. Hear his insights on the topic of sports and wellness for those with a comorbidity or chronic health condition.

[00:00:00] Ayanda Charlie: Welcome to The Sports Series, powered by Mediclinic. I’m your host Ayanda Charlie. As a multimedia content producer with a love for journalism, I am here to ask all the questions you might have, chatting to the specialists to get real answers. Keep looking out for our future episodes as we have a great line-up of doctors

[00:00:20] Ayanda Charlie: and other experts to support you with all the information you need for your fitness journey, no matter what level of sports you play! Please note that the views shared by any of our guests in this podcast, may not necessarily reflect the views of Mediclinic, so please consult a medical professional if you have concerns.

[00:00:38] Ayanda Charlie: When someone is diagnosed with a chronic illness or condition, there are usually many changes they may need to make in their life. Today we are looking at how this may affect the sports or physical activity that the person does. Along with my guest today, we will embark on a journey to discover the incredible benefits, challenges,

[00:00:55] Ayanda Charlie: and triumphs that come with engaging in sports while managing these conditions. Today’s expert medical professional will provide insights, advice, and practical tips on how to navigate the world of sports and exercise in a safe and empowering way. So, let’s lace up our shoes, and get ready to explore the remarkable intersection of sports and wellness for individuals with co-morbidities or known in layman’s terms as chronic conditions.

[00:01:21] Ayanda Charlie: As we look at this important topic today, we will be joined by Dr Elmo Pretorius. Dr Pretorius is a specialist in both endocrinology and internal medicine. Today he will be sharing his insights and expertise with us as we explore the topic of sports and wellness for those with a co-morbidity or chronic health condition. Welcome, Dr Pretorius!

[00:01:40] Dr Elmo Pretorius: Um, I'm Elmo Pretorius. I'm a specialist, physician and endocrinologist at Mediclinic Vergelegen in Somerset West in the Western Cape. I deal a lot with diseases of lifestyle. Um, I also deal a lot with chronic illnesses, and I have a true passion for lifestyle medicine and how people through healthy living [00:02:00] can be the best versions of themselves.

[00:02:02] Ayanda Charlie: I wonder if you can give some examples of the type of health conditions we're talking about today. You know, what health conditions fall under the category of comorbidities or chronic conditions.

[00:02:12] Dr Elmo Pretorius: So we are basically talking about any condition that has inflicted a permanent damage to your body. You know, so you might have had severe covid pneumonia, for example, and now struggle with the after effects from that infection.

[00:02:28] Dr Elmo Pretorius: Or you are suffering from a condition that, um, cannot be cured or which cannot be be reversed. You know, this might be high blood pressure, diabetes, asthma, epilepsy, you know, many of these chronic conditions that many people suffer of.

[00:02:45] Ayanda Charlie: If you weren't unsure whether you might have one of these conditions, what signs or alarm bells could you look out for when exercising?

[00:02:51] Dr Elmo Pretorius: I think firstly, when you're exercising, you're experiencing pain. You know, pain is never a symptom to ignore. You know, maybe if your muscles are burning a bit because you, you know, going [00:03:00] at it too hard, you know, that is fine, but you know, any form of chest pain or a joint that's, that's painful or any throbbing dullness, um, anywhere.

[00:03:08] Dr Elmo Pretorius: You know, that is something you need to, you know, maybe have checked out. I think if you start becoming like really dizzy whilst you're exercising, that would also be a symptom to rather take note of than to, than to ignore. If you're more short of breath than usual, you know, usually, you know you're able to run five kilometers easily and all of a sudden you realize this is becoming an issue for you.

[00:03:31] Dr Elmo Pretorius: You know, there might be something wrong with your heart or with your lungs or so forth.

[00:03:35] Ayanda Charlie: And would you recommend getting your regular health screening regardless of any symptoms?

[00:03:39] Dr Elmo Pretorius: Yeah, I think that was something interesting that we experienced during the Covid pandemic, you know, is that healthy people don't generally go and see doctors, but Covid kind of made people go and see doctors because they were concerned about their health.

[00:03:52] Dr Elmo Pretorius: And we certainly picked up a lot of people with undiagnosed chronic conditions that they didn't know of because they came to doctors [00:04:00] to, to speak about, about Covid. And you know, there are certain guidelines and suggestions in terms of what you know, every healthy person should have done every year. I think every person should, at least every year, their blood pressure checked, have their cholesterol checked, have their glucose checked.

[00:04:15] Dr Elmo Pretorius: Women need to think about cervical cancer screening and mammograms. The elderly need to think about osteoporosis treatment. The men need to think about prostate health. And I think also very importantly, you know, is that you, you know, look at your mental health and you know, and I think it's very encouraging that many of our medical aides are encouraging people to proactively screen themselves for these conditions.

[00:04:37] Dr Elmo Pretorius: Because if you catch them early enough, these conditions are not allowed to cause any permanent damage to your body and you know, that's what we want to avoid. We don't want you to end up in hospital with a complication of a condition you never knew you had. We'd rather be proactive and test you for that condition even before you start showing symptoms of it.

[00:04:59] Ayanda Charlie: And Dr Pretorius, if you've been diagnosed with one of these conditions, is it safe to continue exercise regime as before, or should you consult a doctor first and why?

[00:05:09] Dr Elmo Pretorius: Well, certainly it, it depends on the condition, you know, certain conditions, you know, exercise is not really affected by the condition.

[00:05:15] Dr Elmo Pretorius: And whilst other conditions are strongly affected, you know, if you're diagnosed with depression, you know, There isn't really a reason why you shouldn't be exercising or, or tailoring your exercise. Whilst if you've been diagnosed with, you know, angina of your heart, you know, you might need to consider, um, what, how exercise is gonna influence the disease.

[00:05:34] Dr Elmo Pretorius: And I think it's important, you know, there are two aspects that needs to be considered. The first thing is, does your condition make you safe for the exercise you're doing? You know, if you are doing open ocean swimming, um, with type one diabetes, and you can experience severe low sugars whilst in the middle of the ocean.

[00:05:51] Dr Elmo Pretorius: You know, that might be of, you know, endangering you in that activity but then also similarly, the exercise can worsen the condition and as I've [00:06:00] mentioned, you know, specifically a heart disease can often be worsened if you, um, exercise incorrectly in that regard and I think that's where it's important to speak to your doctor because the doctor can gauge in terms of how the disease puts you at risk for the activity and how the activity can worsen your, your disease.

[00:06:18] Ayanda Charlie: How can participating in sports or any physical activity benefit individuals with comorbidities? Are there specific health improvements that can be expected?

[00:06:25] Dr Elmo Pretorius: Well, I think there's the global advantage of when you exercise people tend to lose weight, and I cannot think of a single comorbidity or chronic illness that doesn't improve.

[00:06:38] Dr Elmo Pretorius: Um, if you lose weight. These conditions become easier to manage. I think a second advantage, you know, if you've got a comorbidity when you exercise, your body is fit and you're well conditioned to adapt to stress and things like that. You know, an example would be a person with asthma, for example, that is quite fit.

[00:06:59] Dr Elmo Pretorius: If that [00:07:00] person were to get pneumonia, they've got a lot of reserve to tap onto when they do become sick, so they're less likely to have a severe asthma episode. But then similarly also, we do see that some diseases specifically require exercise as part of the treatment. I'm specifically thinking about cardiovascular illness.

[00:07:20] Dr Elmo Pretorius: You know, if you've had a heart attack, then you know, part of your rehabilitation is actually exercise to get your heart stronger and get your heart going again. In my field of diabetes, you know, exercise makes diabetes easier to treat. We can use less drugs if I can get my patient to, to exercise. So exercise prescription in diabetes is very, very important as it is in many other chronic conditions.

[00:07:48] Ayanda Charlie: Are there certain types of sports, uh, or exercise that are generally more recommended for individuals with comorbidities or chronic conditions?

[00:07:56] Dr Elmo Pretorius: Yeah, so I think people who struggle with musculoskeletal or [00:08:00] neurological, um, problems, you know, there we really want to look at the, the mobility, um, and the strength, you know, especially core strength becomes very, very important.

[00:08:09] Dr Elmo Pretorius: You know, if you've got back issues and things like that, you know, increasing your core muscle strength, um, becomes quite important but then, you know, joint specific, you know, we want to strengthen the muscles around the joint in specific manners, you know, that the load is taken off the joint, um, for most of the other comorbidities.

[00:08:29] Dr Elmo Pretorius: You know, we want to, we want to have, um, cardiovascular, um, exercises. You know, we want to improve the, the lungs capacity. We want to improve the hearts capacity. But if you've got musculoskeletal problems, it is important that, you know, if you do do cardio, you know that you don't worsen your musculoskeletal problems.

[00:08:48] Dr Elmo Pretorius: So, for example, if you struggle with knee problems, probably running will not be the best exercise for you. You should rather look at something like swimming. Um, for example, we would take the load off the [00:09:00] joint, but generally we, we do encourage patients to increase their cardiovascular fitness, um, rather than their strength necessarily.

[00:09:09] Ayanda Charlie: And are there certain forms of exercise that should be avoided for those with specific conditions? For example, would it be unsafe for a person with asthma or heart condition to do high intensity interval training or cardio exercises, or should someone with chronic back pain avoid weight training?

[00:09:25] Dr Elmo Pretorius: So, as I've said, you know, if you've got specific joint issues, you know, you wanna avoid exercises, that are gonna make that joint issue worse.

[00:09:33] Dr Elmo Pretorius: And, um, that you, you try to take off, off the load, off that joint. Also, in terms of, you know, if you've got cardiovascular disease, for example, you know, the exercise cannot be too strenuous on the heart, you know, it needs to be greater then gradually increased. Not necessarily avoided, but you need to be very careful when you start introducing these types of exercises in [00:10:00] patients with comorbidities.

[00:10:02] Ayanda Charlie: How about an individual with type two diabetes? Are there specific considerations or precautions they should take when engaging in sports or exercise? And do you have any recommendations regarding blood sugar monitoring, medication adjustments, or just dietary modifications that should be taken into account when participating in sports or exercise for type two diabetes?

[00:10:22] Dr Elmo Pretorius: So I think it's important for a person with type two diabetes to discuss exercise first with the doctor. You know, they might have an underlying issue that they're not allowed to exercise, so maybe undiagnosed cardiac disease or something that we are concerned about is what we call peripheral neuropathy.

[00:10:40] Dr Elmo Pretorius: Where they cannot actually feel their feet, you know? So if you start going hiking and you can't feel in your feet, you know, you can get blisters on your feet and that can cause, um, an infections and a lot of complications. So I think it is important to discuss with your doctor the type of exercise that you would want to do, and [00:11:00] whether it's safe for you to do that exercise.

[00:11:02] Dr Elmo Pretorius: But I've mentioned exercise prescription and it is something that's, there's a big advocacy for exercise prescription in type two diabetes and we actually prescribe 150 minutes a week of moderate exercise. So that's exercise that allows you to talk but not sing. So you can kind of guess, you know, what type of intensity we are looking for.

[00:11:23] Dr Elmo Pretorius: And we are looking for at least 150 minutes of, of that. And it certainly makes a big difference in our, our treatment for type two diabetes. We, we can use less drugs if we can get our patients to move often. I think in type two diabetes, one of our big concerns with our therapies is that our therapies tend to make sugar go low.

[00:11:48] Dr Elmo Pretorius: So if you are exercising, you are consuming glucose, and you need to consider whether the drugs that you are on and certain of the drugs are quite safe in exercise, but there may be [00:12:00] drugs that can make your sugar go low during exercise and that you might either need to change the medication or you need to think how you eat during exercise or having some sweets with you when you're exercising or something.

[00:12:13] Dr Elmo Pretorius: But once again, I think that is something that you should be discussing with your doctor when engaging in, in exercise, but I cannot stress it enough. That exercise forms part of the treatment for type two diabetes.

[00:12:27] Ayanda Charlie: What are some other potential risks or considerations that individuals with comorbidities or chronic conditions should be aware of when engaging in sports?

[00:12:34] Dr Elmo Pretorius: You know, the exercise itself might become dangerous if a person experiences a medical problem during exercise. Now, specifically thinking of exercises that would, you would be in isolation, you know, as I've mentioned, open water swimming or something like that, that you cannot reach medical help at that time, or that the exercise happens.

[00:12:55] Dr Elmo Pretorius: For example, at high speed. You know, I'm thinking about mountain biking and those kinds of [00:13:00] exercises. If you run into a medical problem whilst participating. You can, you know, really endanger yourself. Also, if your medical condition is not stable, uh, exercise might exacerbate the, the condition. And, you know, cardiac illness comes to mind there.

[00:13:16] Dr Elmo Pretorius: Where if you've got, for example, unstable angina. Exercising, you know, is just gonna add fuel to the fire with, with your underlying cardiac conditions. So I think the message should be clear that you need to discuss this with your doctor and don't just go off and start a vigorous exercise program.

[00:13:36] Ayanda Charlie: We’ll be back with you shortly, Dr Pretorius. But first, we wanted to share the details of the Mediclinic 24/7 Helpline. You can call the number +27 86 023 3333. The 24/7 Helpline is no longer only for medical enquiries but can even go as far as assisting you with making a booking for the doctor.

[00:13:57] Ayanda Charlie: Back to you, Dr. Pretorius. [00:14:00] So far we've spoken about participating in sports for someone who's already living with a chronic health condition. But what about someone who isn't? How can a healthy lifestyle contribute to staying free of any chronic conditions and what would that lifestyle look like? The role of diet seep exercise, something like that.

[00:14:17] Dr Elmo Pretorius: Well, I've already alluded to what we saw during the Covid Pandemic, and we certainly saw that in Covid Pandemic, that healthy individuals did better, you know? And even if they had terrible Covid, they survived because their bodies had a lot of resilience. You know, a lot of physiological capacity, um, that we could work with one once they got got infected with, with Covid.

[00:14:42] Dr Elmo Pretorius: And this holds for any other medical, um, condition. You know, people who are fit, people are not overweight, they're easier to examine, they're easier to give medicines to, they're easier to give an, an aesthetic to. They are easier to operate on. So [00:15:00] building that reserve for when you are possibly going to be ill in future, you know, does add a lot to, to your chances of survival.

[00:15:10] Dr Elmo Pretorius: You know, not only of living, but being free of permanent damage. You know, if you do have an illness that that comes across your path that you could not have prevented. We know that, you know, just basic things like good quality sleep makes an enormous difference in our health. There's a clear, um, relationship between many chronic conditions and poor sleeping, you know, dementia, diabetes, obesity related to people not sleeping, uh, in enough.

[00:15:38] Dr Elmo Pretorius: You know, finding time to relax, finding time to reflect on your life, it's got significant health implications. People who are just 24/7 working, you know, day in, day out, never getting time for themselves. There are a lot of hormonal things that happen in your body that is negative to your long-term health.

[00:15:58] Dr Elmo Pretorius: You, you, and you [00:16:00] get these comorbidities, like high blood pressure, high cholesterol, depression, things like that. So I think those basics are very important, but I cannot stress enough the effects of diet. You know, ensuring that you are eating healthily is incredibly, um, important. You know, we know, you know, that, you know, certain cancers are related to, to the foods that we are eat, that we are eating.

[00:16:25] Dr Elmo Pretorius: We know that, um, being overweight can cause many, many conditions from joint issues, diabetes, certain cancers, cardiovascular disease, you know, so looking at not overeating, um, is important. Looking at getting the right types of food into, into your diet, um, you know, can prevent many, many diseases. You know, I'm thinking about, you know, having enough iron in your, in your diet and, um, preventing anemia, for example of vitamin b12.

[00:16:56] Dr Elmo Pretorius: Um, deficiencies can cause many neurological conditions, [00:17:00] so I always try and keep it simple for my patients when they ask me about, you know, what should I be doing to be healthy? I say, eat a variety of foods. Have that food be as close to nature as possible. The less processed the food, the better. Um, I'm a, I mean, I believe a variety of foods, but you know, getting plant-based foods into your diet is incredibly important.

[00:17:24] Dr Elmo Pretorius: You know, because of those new nutrients that, that you need from the plants, the antioxidants that protect you against cancer, that's very important. Do not smoke, get enough sleep, get enough exercise, and get enough time to relax.

[00:17:39] Ayanda Charlie: If someone who does not do any sports has been recently diagnosed with a chronic condition and told to start exercising, where would you advise them to begin?

[00:17:48] Dr Elmo Pretorius: So as I've mentioned before, I think start with your doctor. Um, get some advice regarding exercise. Is it a good idea? Is it a bad idea for your specific, um, condition? What type of exercises would the [00:18:00] doctor advise? What type of exercises would the doctor discourage you from doing? And I think it is often useful to get professional help to get you into an exercise, especially if it's an exercise that you don't know.

[00:18:13] Dr Elmo Pretorius: If you've never been a runner and you've now been diagnosed with a condition, probably it is better to, you know, go see a biokineticist, that they assess your fitness and maybe just first start with light walking rather than, you know, just hitting the floor running literally. Or a physiotherapist, if you've got some joint mobility issues that they first assess, you know, what would be dangerous for you to do and what would be safe for you to do, and you know, what type of exercise are more likely to improve your condition and to improve your overall health?

[00:18:49] Ayanda Charlie: You speak about consulting a doctor, is that a specialist or would you start with a gp?

[00:18:53] Dr Elmo Pretorius: I think that if you've got a very complicated illness or you've got many, many illnesses that you need to think, uh, [00:19:00] think about together. You know, specialists are usually better at helping you with that. But general practitioners have good sound knowledge of most of the chronic conditions, you know, and just starting with your general practitioner should be more than enough.

[00:19:13] Dr Elmo Pretorius: And of course, that person can refer you to a specialist if that is necessary.

[00:19:19] Ayanda Charlie: A person diagnosed with a psychiatric condition such as depression or anxiety may face unique challenges that are not necessarily physical when it comes to exercise. Could you speak to this example and share some ideas of how to stay motivated to participate in sports or fitness programs?

[00:19:34] Dr Elmo Pretorius: Well, I think an essential part of exercise is exercise needs to make you feel better. It mustn’t make you feel worse. You need to be able to enjoy exercise. And I think a lot of time excuses patients would make when I talk to them about exercises, doctor, I don't enjoy exercising. And my answer to that is, you've just not found the exercise that works for you, or you haven't found a way.

[00:19:58] Dr Elmo Pretorius: To make that [00:20:00] activity pleasurable. So, I think exploring different options, and I think, you know, in terms of online, there are so many options available these days, classes that you can take online. If you, if you're not a person wanting to go to the gym or having to be out in public, you know, you can do exercises online, but, you know, finding something that, that you really enjoy.

[00:20:22] Dr Elmo Pretorius: Or then looking at activities like walking or running and making it more, more fun for you. You know, listening to your favorite music, listening to podcasts whilst you're running, going to places that's, that's, you know, surroundings, that's beautiful for, you know, going in a nature reserve for a hike or around, uh, a beautiful dam, going for a run.

[00:20:42] Dr Elmo Pretorius: Things, things like that, that encourages you and, and rewards you to, to do the exercise. I think many people respond well to participating in a group. You know, having that social connection, you know, and people that support you in, in exercising. I think that's a big motivator for a lot of [00:21:00] people. You know, often, you know, especially people who exercise in the mornings, you know, it's easier, much easier to lie in bed than to get out.

[00:21:07] Dr Elmo Pretorius: But, you know, if there are people depending on you to join the class, you know, you're more likely to, to get out of the bed and, and going out, exercising. I think also important, you know, no one enjoys exercise if you are not fit. You know, I'm a keen runner, but even if I'm unfit, I don't enjoy running. So I think having realistic goals when you start exercising and starting slow, you know, don't just say, oh, all right, I'm gonna start running five kilometers.

[00:21:33] Dr Elmo Pretorius: You run five kilometers and you hate it because you were not fit enough. You know, start slow. Um, but set yourself the goals. You know, sit, say, okay, well I'm gonna start with a kilometer walk. Now I'm gonna do two kilometers walk. Okay, I'm gonna do two kilometers running. You know, slowly build up to the point. [00:21:51] Dr Elmo Pretorius: But set yourself that goals because reaching those goals, it's immensely positive on your sense of [00:22:00] achievement and your sense of wellbeing and, and your, and your mental health. Um, so I think, you know, take it slow, set the goals and um, find people who would act as cheerleaders for you. You know, people who encourage you to, to, to do the exercise.

[00:22:18] Dr Elmo Pretorius: Um, but you know, obviously some people they enjoy doing things by, by themselves and that's also fine, but, and, and set yourself some rewards, you know, if you attain those goals. And, and I think that just makes exercise all the more pleasurable.

[00:22:32] Ayanda Charlie: Finally, Dr Pretorious, can you provide examples or success stories, right, of individuals with comorbidities or chronic conditions who have benefited from regular sports participation or exercise?

[00:22:43] Dr Elmo Pretorius: Sorry, Ayanda now you would get me going. I mean, I've got an absolute passion for people who suffer with lifestyle diseases where it's so sad for me to see that they're on all these medications and actually the cure is in their hands. And I think I started [00:23:00] the, this, this conversation was saying, you know, these are diseases that cannot be cured.

[00:23:05] Dr Elmo Pretorius: And, and actually that's not true. Lifestyle’s diseases can be cured through healthy living. For example, I'm gonna use is diabetes and if I see young people with diabetes and if I talk about a young person, I'm talking about a person who's younger than 55 and they now have diabetes, I have to tell them.

[00:23:24] Dr Elmo Pretorius: But you know, the chances that you're gonna reach a old age without this disease affecting you in some way, um, is very, very slim. Unless you get rid of this disease, you know, I can give you medication, I can damage control your lifestyle. But only for so long before you're going to run into trouble. And certainly I've had many, many young people who have told this that made some positive changes in the way they eat, in the way they exercise, and that now are completely cured from their diabetes.

[00:23:56] Dr Elmo Pretorius: They do not need any drugs any further. [00:24:00] To control their illnesses. And I think people are often so desperate for natural solutions. You know, I would say to a patient, you need this drug to manage this condition. They're like, doctor, but isn't there something natural that I can use? And I'm also like, yes, there's definitely something natural, you know, diet and exercise.

[00:24:17] Dr Elmo Pretorius: And I would encourage people not to just look for a doctor to supply them with a medical solution, A drug that will fix their problem. But rather holistically at addressing their problem through diet and exercise because that can provide the cure for these lifestyle diseases. So, I can certainly, um, mention or think about many cases of patients of mine that, you know, had a rude wake up call the day they visited my office in terms of what's gonna happen to them if we just go the medical route.

[00:24:49] Dr Elmo Pretorius: Um, and if they don't, you know, make some changes to their lifestyles. And, and I've had patients who I deprescribed all of their medications. They do not need a single medication to [00:25:00] manage their comorbidity. Um, they certainly need to know that they are lifelong at risk to develop this condition again.

[00:25:09] Dr Elmo Pretorius: Um, but you know, if they do maintain the, the healthy living, you know, that they're likely to remain, um, disease free. But, you know, I, I cannot say that, you know, diet and exercise is always going to provide, um, the cure. You know, if you've had diabetes for a long time, you know there's already a lot of damage to your body and to, you know, your organs, that the disease might not be reversible, um, anymore, but that should still not discourage you from, youmknow, living healthily and avoiding medication as far as possible.

[00:25:43] Ayanda Charlie: Dr. Pretorius, thank you so much for being with us today.

[00:25:45] Dr Elmo Pretorius: It's a pleasure. Thank you.

[00:25:46] Ayanda Charlie: As we conclude, one thing becomes evident: physical activity has the power to transform lives. While it is important to consider the unique needs and limitations of individuals with certain conditions, the benefits of regular exercise are undeniable. From improved cardiovascular health to enhanced mental well-being,

[00:26:07] Ayanda Charlie: participating in sports can positively impact various aspects of life. However, it is crucial to work closely with healthcare professionals to develop a tailored plan, and to ensure safety and maximise the benefits. Remember, if you are living with a chronic condition, you are not defined by that condition but by your determination to live a fulfilling and active life!

[00:26:28] Ayanda Charlie: Embrace the opportunities, overcome the challenges, and allow sports to be a powerful tool in your journey towards health and happiness. Thank you again to Dr Elmo Pretorius for being with me today. And to all of you who joined me in listening to this episode of The Sports Series podcast, powered by Mediclinic.

[00:26:46] Ayanda Charlie: If you haven’t yet done so, subscribe to our podcast channel and sign up for the Mediclinic Prime newsletter, packed with great health articles; a bi-weekly series of newsletters focused on young families – the link is in the show notes too. Until next time.